Daptomycin-Induced Hyperkalemia as an Early Sign of Rhabdomyolysis in a Diabetic Patient

Daptomycin is a lipopeptide antibiotic that is active against vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA). It is less nephrotoxic than vancomycin. It has a unique bactericidal mechanism through destruction of bacterial membrane potential. However, one of the most clinically relevant adverse effects of daptomycin is reversible myopathy, especially when daptomycin is used in high doses. Here, we present a case of a patient with rhabdomyolysis preceded by hyperkalemia associated with daptomycin use. Soon after daptomycin administration, hyperkalemia was noticed before the acute rise in creatinine phosphokinase (CPK). The serum levels of potassium and CPK returned to normal after daptomycin was stopped which suggested the causal relationship between hyperkalemia and myopathy and daptomycin use. To our knowledge, this is the second case of hyperkalemia related to daptomycin use.